Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines
Introduction
In 1992 the European Resuscitation Council (ERC) published the first set of internationally recognized guidelines for Advanced Life Support [1]. These were based upon scientific and clinical information available at that time, recognizing that as further information became available, there would be the need for modification. In 1997, the International Liaison Committee on Resuscitation (ILCOR) issued their Advisory Statement on Advanced Life Support (ALS) [2]. The mainstay of this statement was the proposal of a universal algorithm, which emphasized the importance of early identification of VF/pulseless VT and rapid defibrillation. In April 1997, the Resuscitation Council UK decided to adopt the advisory statements on behalf of the European Resuscitation Council (ERC). The aim of this study was to try and assess the effect of implementing the 1997 guidelines by auditing outcome following cardiac arrest in a group of hospitals throughout the UK.
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Materials and methods
Resuscitation Training Officers (RTOs) in District General and Teaching hospitals throughout the UK were recruited to gather data on in-hospital cardiac arrests occurring in adults (>16 years of age) in the 6-month period, May–November 1997. Patients undergoing cardiopulmonary resuscitation on arrival at hospital were excluded. The data for each cardiac arrest were collected using a standardized form based upon the recommendations of Cummins and colleagues for in-hospital cardiac arrests [3].
Results
Details of in-hospital resuscitation attempts were obtained from the RTOs in 49 hospitals. The total number of cardiac arrest calls logged by hospital switchboards during the study period was 3942, not all of which were to patients requiring cardiopulmonary resuscitation. Analysis of cases in those hospitals which were able to identified the true reason for the call showed that only 2477 out of 3366 (73.6%) were to patients requiring cardiopulmonary resuscitation.
The total number of audit forms
Discussion
The aim was to assess the impact of adopting the ILCOR advisory statement for the management of in-hospital cardiac arrest in adults. It is well recognized that audit of resuscitation and collection of reliable data are difficult. The present study set out to try and audit all cardiopulmonary resuscitations in participating hospitals, but our data suggest that identification of all such events may not be possible. Hospitals frequently initiate a ‘cardiac arrest’ call incorrectly or simply
Acknowledgements
The authors would like to express their sincere thanks to the Resuscitation Council (UK) for funding this study and to the following RTOs who submitted data: Celia Warlow, Joanne Atkinson, Mark Whitbread, Mike Harris, Jane Roberts, Colin Murray, Noreen Lewis, Keith Bruce, Kevin McCusker, Pat Snowden, Carolyn Williams, Nikki Douglas, Peter Snell, Shaun Essery, Susan Dowling, Jill Tempest, June Conners, Katherine Basset, Rose Oughton, Brenda Cottam, Susan Barber, Dave Edwards, Ken Spearpoint,
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